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Vanishing Twin Syndrome (VTS), Part 2

This article is for information and overview purposes only and does not represent every possibility or situation.  If you are concerned about any aspect of your pregnancy, please consult your doctor as affects your particular situation.

The use of diagnostic ultrasound imaging has made it possible to determine as early as five or six weeks that Mom is pregnant. Ultrasound (US) picks up the fetal heartbeat(s) allowing the medical team to also determine how many fetuses are present. In some cases, two or more fetal heartbeats can be found leading to excitement and some trepidation for the expecting parents. The use of US to determine pregnancy at such an early stage, however, has also identified another issue which might occur known as Vanishing Twin Syndrome (VTS).1  For women experiencing VTS, during a subsequent US (up to about 12 weeks gestation), one or more fetal heartbeats may no longer be found. The empty sac may, or may not, be visible on the screen.

In years past, women had their first US after the 12th week of gestation therefore eliminating the possibility of knowing that they were initially carrying more than one fetus. The availability of US as early as the 5th week of pregnancy has allowed researchers to conclude that the rate of multiple-birth conception is much higher than previously thought. It is estimated that one in eight people may have started as a twin, but only one in seventy pregnancies actually resulted in a twin birth.2  VTS usually has no symptoms, but sometimes a pregnant woman might have unexplained bleeding, cramping or passage of tissue in the week(s) in her first 12 weeks of pregnancy. Such symptoms could indicate the loss of a multiple pregnancy, a blighted ovum, or in some cases nothing at all. Not all cases of VTS are associated with any outward signs and many women continue with an uncomplicated pregnancy and the birth of a healthy child(ren).

VTS does not just occur with twin pregnancies, but can occur within higher order multiple sets as well. The loss of one, or more, embryo in the first trimester can be emotionally devastating for expecting parents. For example a couple was 8-1/2 weeks pregnant with triplets when they registered for a multiple-birth prenatal class.  When they arrived for the class at just over 13 weeks pregnant, they advised that a subsequent ultrasound had shown that they were now carrying two babies, and an empty sac had been visible on their latest ultrasound.  The couple had a difficult time because two other couples in the group were carrying triplets and they realized they were no longer part of that special group.  In such cases, referral to counseling may assist expecting parents in dealing with their early fetal loss and allowing them to celebrate in their continuing pregnancy.

Risk factors for experiencing VTS are generally unknown but seem to include a maternal age over 30. If the vanishing fetus occurs in the first trimester, as it does in most cases, no medical intervention is usually necessary. The mother, the placenta or the surviving co-multiple may absorb any miscarried fetal tissue within a few days.

VTS does not generally affect the ability of a woman to conceive again, although there could be underlying genetic or health issues that should be explored with a physician.

While VTS usually poses no problem physically for the mother or the surviving child(ren), it is not uncommon for mothers to have feelings of disappointment, grief and loss as they had anticipated and looked forward to a multiple-birth.3  As the pregnancy continues with at least one healthy child, these mothers may be told that the loss isn’t important or to focus on their healthy baby. It can be difficult for mothers to find acceptance or a safe place to grieve this loss as family and friends fail to understand that a unique parenting experience has also been lost as well as a much-wanted child. Women and their partners experiencing VTS are encouraged to seek counseling if feelings of depression, sadness, or anxiety continue.  Local and national parenting support groups may offer networking opportunities for parents who have suffered from VTS.

Vanishing Twin Syndrome (VTS), Part 1

See Part 1 of this article, Vanishing Twin Syndrome (VTS)

References

1) De la Fuente, G., Puente, J., Garcia-Velasco, J., & Pellicer, A. (2011). Multiple pregnancy vanishing twin syndrome. In Biennial Review of Infertility (pp. 103-113). Retrieved from http://link.springer.com/chapter/10.1007%2F978-14419-8456-2_9?LI=true

2) Heim, S. (2007) It’s Twins! Charlottesville, VA: Hampton Roads Publishing.

3) American Pregnancy Association. (2007). Vanishing Twin Syndrome. Retrieved from http://americanpregnancy.org/multiples/vanishingtwin.html

Additional Resources

Mothering Multiples, by Karen Kerkhoff Gromada, La Leche League International

The Art of Parenting Twins, by Patricia Maxwell Malmstrom and Janet Poland, Ballantine Books

Twins! Pregnancy, Birth and the First Year of Life, by Connie L. Agnew, Alan H. Klein and Jill Alison Ganon, Harper Perennial

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Loss in Multiple Birth

In spite of everyone’s best efforts, there is a chance that you may lose one, more or all of your babies. In an effort to assist you face this difficult time, to guide you when you have to make certain difficult decisions (e.g. whether or not to see or hold your baby(ies), taking pictures, funeral arrangements) and offer ideas on how to deal with others’ remarks, the following has been prepared. May you find some comfort from these suggestions.

Vanishing Twin (occurs by about 12 weeks gestation)

Vanishing Twin occurs when at least one embryo does not develop probably due to the fact the embryo was not able to properly attach itself to the uterine wall to get the maternal nutrition it needed to properly grow and develop.  The embryo dies and is reabsorbed by the placenta or the mother’s body.  Vanishing Twin is not anyone’s fault.

Miscarriage (occurs up to 20 weeks gestation)

If you have lost your babies through miscarriage, you may feel empty or angry with yourself and let down by your body. You may blame yourself, your actions or attitudes or even that glass of wine or cup of coffee. You may find that friends, family or hospital staff don’t acknowledge the pregnancy or the depth of your grief. Remember, this has been a very real pregnancy for both you and your paratner. You have visualized the babies, ‘taken them for a walk’, ‘bathed and dressed them’, amongst other things.

You might wish to try to find out why your miscarriage occurred. Be prepared for the fact that there might be no definite answers. Try not to feel guilty. Talk openly about your feelings and the babies with a caring person. If desired, maintain some contact with the your local twin and triplet support club until you feel ready to let go.

Stillbirth/Infancy (after 20 weeks gestation)

Prematurity is still the leading cause of death in a multiple birth situation. There is no guarantee against the early delivery of your babies. In spite of the best precautions, it can still occur.

Grief can occur on two levels: at one level, the loss of a unique type of parenting experience; and the other the loss of your baby(ies). The emotions experienced can be varied and sometimes not even feel as if they make any sense: “Did I prefer one baby over the other?”, “Did I really only want one?” Be sure and talk about your feelings with a caring person. You may experience inner struggles as you try to deal with the joy of the birth of one baby and the loss of another. You may wish to push all thoughts of the dead baby from your mind and concentrate on your living baby(ies). You may be subjected to thoughtless remarks from family or friends – ‘you couldn’t have handled triplets anyway.’ ‘At least you still have a baby.’ ‘You have some babies who need you, get on with it!’ It is helpful if you take time to grieve your loss. We cannot move forward until we have grieved what we have lost. Children are not interchangeable and we cannot ignore the death of one because others have survived. Don’t be shy about reminding others that you have lost a baby(ies) and have every right to mourn for him (them).

Some important feedback received from bereaved parents:

  • Name your baby(ies)
  • See your baby(ies) if you can. Hold them, touch them, bathe them and dress them. Take all the time you need. Such contact helps with integrating the fact that your baby is dead. We cannot say ‘good-bye’ before we have said ‘hello’. The majority of bereaved parents find solace, comfort and some healing in seeing their baby(ies). Some grieving parents do not want to see their baby(ies). Don’t be talked into anything that you do not wish to do or which does not feel right for you. Whichever works for you is right way to proceed.
  • Take photos. Take pictures of your babies together and alone, as you wish. The photos can be put away until such time as you feel you might like to look at them or, if you feel unable to take the photos yourself, have a hospital staff member or good friend take some.  Over time, some parents report the photos help acknowledge that their baby(ies) really did exist.  These photos can also become very important for the surviving co-multiple(s) in understanding about their beginnings.
  • Ask any questions of your doctor that you might have. Ask until you have answers that you understand. Be prepared, however, for the fact that some questions may have no answers.
  • Plan the funeral or memorial service as you wish.
  • Don’t keep feelings bottled up inside of you. Talk with a caring person whenever you need. Join a local bereavement support group. This is important for both Mom and Dad/Partner.
  • As the parents, try to spend set aside some time to spend together to share your grief and lost dreams.
  • Be prepared to have ‘set backs’ – this is normal. We are not the same people we were before the death. We need to get used to a new reality. The loss of child stays with us forever and we need to learn how to incorporate our grief into our everyday lives so that we can keep on living. Be prepared to have grief feelings triggered for no seemingly apparent reason. Don’t ignore them. It is only by going through these painful feelings that we can eventually begin to feel any peace.
  • You may wish to think about including older children in the funeral in a meaningful way:  draw a picture, pick out the burial outfit, and such.
  • Try to include the grandparents in some meaningful way in either the funeral or memorial service. They too have a lot to deal with. They have lost a grandchild(ren) and in addition, have not been able to protect their own children from such terrible pain.

There are many good books available on grief.  Check your local Library and perhaps the library of your local twin and triplet support Chapter. Many are available on line at Amazon.com  In addition, Multiple Births Canada has written two booklets on loss and they are available from their Business Office. Multiple Births Canada also has a Loss Support Network which issues a monthly e-newsletter (except December), has confidential e-mail connection between the members and can refer you to appropriate support persons. If you already belong to a member Chapter of Multiple Births Canada, there is no charge to join the Loss Support Network although a donation of your choice to help defray printing and web site costs is greatly appreciated.

Please don’t feel alone in your grief. There are many caring people available to assist you.

Other Support Contacts:

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Multifetal Pregnancy Reduction

Note: The term used by the International Society of Twins Studies (ISTS) is “Multifetal Pregnancy Reduction” and is the one used here. For the Reader’s information, this procedure may also be referred to as “Selective Reduction”.

Couples who are expecting three or more babies may wish, or be advised, to consider reducing the number of viable fetuses to two. The reduction procedure is usually performed between the 10th and 12th weeks of pregnancy by injecting one or more of the fetuses. Fetal reduction increases the chance of a mother having one or two healthy babies instead of a miscarriage or very premature delivery of three or more babies who are much more likely to die or to suffer from long-term disability.

The balance of risk and advantage will be different for each couple but nevertheless for all there will be a sense of responsibility and much anxiety. For couples considering multifetal pregnancy reduction, there are additional issues that compound their anxieties.

Firstly, many couples have struggled with becoming pregnant, sometimes for years. Here they are pregnant, with some type of fertility assistance, but they are carrying triplets, quadruplets, quintuplets, sextuplets or more. To now have to consider reduction (killing?) of some (or even one) of the babies that they have strived so hard to conceive, goes against all of the time, energy, disappointment, heartbreak and money that was invested in getting pregnant in the first place.

Secondly, when it is determined that there are three or more fetuses, the timeframe for the multifetal reduction choice is often very narrow, sometimes as short as only 3 or 4 days. In that small window, the parents have to learn all they can about the procedure, perhaps connect with others who have had the procedure, learn about the risks to mother and the remaining fetuses and come to grips with losing (aborting? killing?) one or more of their unborn children. This is enormous pressure to endure, to come to terms with and to decide upon in a few, short days.

Thirdly, and as yet perhaps one of the most unstudied and unrecognized issue, are the possible long term psychological effects on the parents and by extension, the children as well of choosing a multifetal pregnancy reduction procedure. Some of the questions that have been bandied about my parents having had the procedure are: “Did we kill our son?” (this from parents who had two beautiful daughters from a triplet pregnancy); “Am I a murderer?” “How and when do we tell the others (surviving children)?” Some parents have reported fantasizing about the baby(ies) that was reduced and wondering about the sex of that child(ren), if they would have looked like their co-multiples and even if they should tell the siblings about the reduction. Some parents have named the reduced child(ren) in an attempt to come to terms with their decision and to find some peace regarding this socially unrecognized loss.

Regarding telling the other children about the procedure and what it could entail, once again the answer will be individual and personal. If you have shared with other family members that you are carrying many fetuses and are considering multifetal reduction, then have the procedure and wish to keep hush regarding your decision, it may already be too late. If parents choose not to tell their surviving children but have conferred with other family members regarding the procedure, then there is always a risk that someone will tell, even inadvertently, your surviving children. Secrets in a family are extremely hard to keep and usually fester and erupt at a most inopportune time and sometimes awkward moment. It stands to reason that parents considering the multifetal reduction procedure would want to confer with other family members who love and care for them, as they struggle with emotions, guilt, worry and anxiety over their babies. To share personal information and then to expect silence may be too much. A child who discovers, from someone other than his parents, an important piece of his history can become confused and angry regarding this important piece of his life which has been kept from him.

With families being more open these days and encouraged to speak of their dead baby, this could be helpful all around. It is usually better for children to know from the start that they were once a part of a set. The reaction of each child will be unique and personal and parents will need to provide age appropriate feedback and information to their children’s questions. The beauty of this approach is that, a child asks at his or her own rate and in a manner that meets his or her needs at that time. Expect questions at all stages of their lives.

When considering multifetal pregnancy reduction, there are many questions and the answers will need to be considered individually and as will affect each family’s personal situation. Here are a few common questions:

I am expecting quadruplets and am being asked to consider reducing to twins. I know it is possible to carry healthy triplets, what do we do?

You are correct, many families have carried triplets to a healthy outcome. There are many considerations and only you, your partner, informed healthcare professionals, perhaps other multiple births parents, genetic counselling can help you reach a decision.

Some things you might consider:

Ascertain the health risk vis-à-vis the mother and all of the babies. If one (or more) fetuses have anomalies, you may feel that reduction is the decision to make, thereby giving the healthy fetuses a better chance at a healthy gestation and life.

Learn the survival statistics

  • 70% of quadruplets survive. Of that figure, 50% of them have disabilities ranging through a series of impairments such as blindness, to cerebral palsy. The average gestation for quadruplets is 28 weeks.
  • 85% of triplets survive and 10% impairment rate can be expected, with an average gestation of 30-33 weeks.
  • 98% of twins survive with a 5% impairment rate and the average gestation is 35-38 weeks (NOTE: a singleton gestation rate is based on 40 weeks).*

*Statistics quoted from research paper by V.M, quadruplet Mom who reduced to triplets and gave birth at 34+ weeks to three beautiful, healthy babies. Their weights ranged from 3.12 lbs. to 4.9 lbs. and the family brought them home from the hospital within 15 days.

Did we do the right thing?

This is such a difficult question and there are no easy answers. Even though the timeframe for decision whether to have the procedure or not is so short, be sure and do your homework. Below are some Internet Sites to visit, talk to other families who have considered the procedure, learn as much as you can about the procedure and the possible ramifications. Knowledge is Power and permits you to make the best possible decision for your personal situation.

I must go back to V.M. thoughts and wisdom. As V puts it:

Someone once said to me “make the decision from your head, not your heart”. I agree with the intent of that comment. An informed decision is the best decision. However, you can never really feel good about such a decision, and you will never be 100% certain of your choice. You can survive this and one day you will be at peace with it. Recently I was able to answer a question that had tormented me from the beginning. “How do I ask forgiveness or understanding from that lost child – the one I never gave a change at life?” The answer – there is no need to ask for forgiveness for a child loves unconditionally. The love we have for that child was and is equally returned. It was through love that my husband and I conceived and it was with love that we reduced. It is the love not the loss that I chose to hold onto. Somewhere between your head and your heart, what you know and what you feel, you will find the answer. Allow yourself to listen to both.

We have lost a child(ren). We hurt so much and we cannot share nor openly talk about our pain.

Multifetal pregnancy reduction is one type of loss that is nearly impossible to ‘share’ with others let alone have them fully understand the anxiety and dilemma that has been faced. We conceived many babies and chose to reduce one (or two, or three). While our dream has been drastically altered, we may choose to keep our personal feelings to ourselves and if not, our loss(es) may not be acknowledged, recognized or even fully understood by others in a manner that we might feel fitting or helpful. A sense of isolation coupled with the grief of the new reality can combine to make the pain greater.

It may not be unusual, like a miscarriage, for others to have difficulty in relating to your loss. “Well it wasn’t a baby yet” or “you have others” may be expressed to you. Try and find a caring and understanding person to share your pain and grief with. It might be a special friend, grief counsellor, religious leader, family doctor or bereavement support gorup. Grief is personal and knows no timetable. Grief is a journey not a destination and may require some support at different stages of your life. It is important to recognize the pain, possible feelings of guilt and grief and to work with them, address and acknowledge them. Only then can we move on, forever changed and with a new reality. Don’t be afraid to cry or seek appropriate professional support, if need be.

Sources

Bereavement: Guidelines for Professionals, These guidelines focus on the particular issues raised by the loss of a twin, triplet or more by Elizabeth Bryan, MD, FRCP, FRCPCH and Faith Hallett, The Multiple Births Foundation
Selective Reduction: Research Tools for an Informed Decision, by V.M.
Twins! Pregnancy, Birth and The First Year of Life by Connie L. Agnew, M.D., Alan H. Kein, M.D., and Jill Alison Ganon, 1997, Harper Perennial

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Vanishing Twin Syndrome (VTS), Part 1

Vanishing Twin (VT): Frequently Asked Questions (FAQs)

To my surprise, the Vanishing Twin article is the most hit-on article on my Site. Due to very early ultrasounds (5 or 6 weeks) we learn early if we are pregnant and with how many. By about week 12, things can drastically change. Following are some FAQs on Vanishing Twin:

LYNDA IS NOT ABLE TO ANSWER MEDICAL QUESTIONS. ANSWERS PROVIDED ARE GENERAL IN NATURE AND MAY NOT APPLY TO YOUR PARTICULAR SITUATION. IF YOU HAVE ANY CONCERNS AT ALL ABOUT YOUR HEALTH OR YOUR PREGNANCY,PLEASE CONSULT YOUR DOCTOR!!

Q – How long will I continue to bleed?

Ans: Each woman is unique as is each pregnancy, even for the same woman.  Duration of bleeding can depend upon when VT occurred. For example if it occurred at 7 weeks, a woman may not bleed as long as if it occurred at 10 weeks. Some women don’t bleed at all and their body reabsorbs the VT tissue with no outward indication of the loss.

Q – Will the VT hurt the other baby (ies)?

Ans:  In the majority of cases, if the other baby(ies) is healthy, it(they) will be fine. Your doctor can confirm, through ultrasound and fetal monitoring, the health of your remaining baby(ies). Generally there will have be no difficulty as the pregnancy progresses through to a healthy birth.

Q – Will there be any evidence left at the birth of the survivor?

Ans: Usually at birth, there is little if anything left of the VT. There might be a “thickening” of a portion of the placenta.  It depends upon when the VT and the birth of the surviving baby occurred as to whether or not the VT is visible. For example: if say the VT occurred at 8 weeks and the birth of the survivor occurred at 39 weeks, there is little chance of any remaining physical evidence of a VT. If the VT occurred at 12 weeks and the survivor is born prematurely, say at 32 weeks, then there may be some evidence of VT or there may not.

Q – What caused the VT? What did I do wrong?

Ans: It isn’t fully understood why VT occurs but it can be surmised that an embryos did not properly attach to the uterine wall and therefore failed to receive adequate nutrition to grow and develop. As can be appreciated from the scenarios mentioned in Ques. No. 3, there can be little to study after birth in order to ascertain why a particular pregnancy failed to produce healthy multiples. Early ultrasounds (at 5 to 6 weeks), can indicate a woman is pregnant and with how many. Two decades or more ago, the first ultrasound occurred much later in a pregnancy, about 16 to 20 weeks, well past when a woman would have known that she was initially carrying two or more. As a result she would have no knowledge that she had been carrying more than one.  It is generally felt nowadays that many more of us begin life as twins than was previously thought. What can be assured is that VT isn’t anyone’s fault and neither parent did any thing wrong.

Q – How long will it take for the empty sac to be reabsorbed by the mother’s body?

Ans: Each case is unique and needs to be evaluated on an individual basis. Your doctor is the best person to advise you for your particular case.

With ultrasound, it is now possible to know as early as five or six weeks that you are pregnant. However, with these first trimester, early ultrasounds an interesting side effect has occurred. The early ultrasound confirms two or more fetuses and a subsequent ultrasound reveals the ‘disappearance’ of at least one of the fetuses and an empty sac may be visible. This ‘disappearance’ is called Vanishing Twin.Researchers now suspect that many more multiples are conceived than previously thought and unexplained bleeding early in the pregnancy may be the miscarriage of a multiple. In the past, women usually had their first ultrasound later in their pregnancy (after 12 weeks pregnant) and therefore would never have known that they were carrying multiples. Nowadays the use of early ultrasound (in some cases as early as five weeks pregnant) can confirm a multiple birth pregnancy, while a later ultrasound confirms the loss of one or more of the babies. While not all cases of vanishing twin are associated with bleeding, this may explain why some women experience some cramping, bleeding or passage of tissue early in their pregnancy, but nevertheless the pregnancy continues, is uncomplicated and culminates with the birth of a healthy child(ren).

Vanishing twin can also occur within higher order multiple sets. I made an initial contact for registration for multiple birth prenatal classes with a family 8-1/2 weeks pregnant with triplets. When they arrived for the first class at just over 13 weeks pregnant, they advised that a subsequent ultrasound had shown that they were now carrying two babies and an empty sac was visible on the ultrasound. This family had very sad feelings because two other families in the class were carrying triplets and they should have been part of that group.

It is not uncommon for families with vanishing twin to experience feelings of sadness, grief and loss as they had anticipated and looked forward to a multiple birth.

It is not clear why one (or more) fetus fails to develop and is either miscarried or reabsorbed into the mother’s system.

For additional information, please see Vanishing Twin Syndrome, Part 2

Some Resources on Vanishing Twin

Twins! Pregnancy, Birth and the First Year of Life, by Connie. L. Agnew, Alan H. Klein and Jill Alison Ganon, Harper Perennial
Multiple Blessings, by Betty Rothbart, Hearst Books
Double Duty, by Christina Baglivi Tinglof, Contemporary Books
Mothering Multiples, by Karen Kerkhoff Gromada, La Leche League International
The Art of Parenting Twins, Patricia Maxwell Malmstrom and Janet Poland, Ballantine Books

Website: www.vanishingtwin.com

Please Note: I am unable to answer any medical questions. If you have any concerns regarding your medical situation, please check with your healthcare professional.

Additional information about ultrasounds and sonograms – particularly relating to diagnostics, exposure principles, and the role of an ultrasound technician – can be found through a variety of medical resources.

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Miscarriage

Miscarriage is the unplanned ending of a pregnancy before the 20th week of the pregnancy. 15 to 20% of all pregnancies end with a miscarriage. 75% of miscarriages occur within the first trimester (12 weeks) for several possible reasons: improper attachment to the uterine wall, imperfect fetus either genetically or more usually, by a chance mutation of cells at the time of conception. 25% of miscarriages occur during the 13th to 20th week. Usually the fetus is normal but there may be other problems: improper attachment of the placenta, uterine difficulties or an incompetent cervix.

There may be several reasons for a miscarriage as discussed above or a mild virus, more serious disease or infection may be the cause. Environmental facts and malnutrition of the mother are two more possible causes.

Many times there are no definite reasons for a miscarriage and we, who prefer answers, may have some difficulty in coming to terms with that fact.

If you lost one more or all of your babies through miscarriage, you may feel empty, angry or let down by your body. Even worse, you may find that family and friends don’t properly acknowledge the pregnancy or the depth of grief. In fact, society tends not to think of miscarriage as a real loss. People tend to think that because you didn’t know the baby, you shouldn’t feel too sad. The loss is downplayed and the parents are often advised to “try again.” If parents are to have any hope of healing, many of those whom have dealt professionally with pregnancy loss or studied it, agree that parents need to grieve their baby’s loss if they are to heal.

If it is possible to see your child, ask the hospital staff in this regard. They are best suited to advise you. Even if the baby can’t be viewed, it might be wrapped in a blanket and brought to you to hold. The physical sensation of holding your child gives you tangible memories of the baby’s real existence as a part of your family. Other mementos, such as copies of early ultrasound photographs of the multiple pregnancy with all fetuses intact, are cherished by many families.

If it is not possible to see the baby due to the miscarriage at too early a stage, it still may be possible to arrange formal burial or cremation with the cooperation of the hospital and a funeral home. If this is not an option for you, it is helpful for many families to hold a memorial ceremony, either officially with religious involvement or personally with only family and friends. You might decide to plant a tree(s) in a special location in memory of your child(ren).

It is important to find a safe place to grieve your loss. You may join a bereavement support group, see a therapist who specializes in pregnancy loss issues, find a caring friend or relative to share your feelings and emotions. Research has shown that parents who do not talk about a tragedy pregnancy take much longer to resolve their grief.

Women usually will grieve longer than men and want to speak of the miscarriage for weeks or months afterwards. Mothers may be receiving adequate care and attention afterwards, but bereaved fathers are sometimes overburdened and overlooked. Not only must they console the mother who just suffered a loss and who may be seriously ill herself, but they must also deal with their child(ren)’s death and memorial arrangements while also juggling household duties and possibly a job as well.

This article was written with grateful input and assistance from:
Dr. Elizabeth Pector, Illinois, U.S.A.

Sources

Bereavement in Multiple Birth, Part 1: General Considerations, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, November, 2001
Miscarriage, pamphlet prepared by Canadian Mental Health Association, Windsor, Ontario, Canada
At a loss, article by Kimberly Pfaff, printed in The Walking Magazine, September/October, 2001

Reading Resources

Twins, Triplets and More, Elizabeth M. Bryan, M.D., St. Martin’s Press
Guidelines for Professionals: Bereavement, Bryan, EM; Hallett F, Multiple Births Foundation, London England www.multiplebirths.org.uk
Living Without Your Twin, Betty Jean Case, Tibbutt Publishing
Bereavement in Multiple Birth, Part 2: Dual Dilemmas, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, May, 2002
The Worst Loss: How Families Heal from the Death of a Child, by Barbara D. Rosof, Henry Holt
Empty Cradle, Broken Heart: Surviving the Death of Your Baby, Deborah L. Davis, Fulcrum Publishing
Men & Grief, Carol Staudacher, New Harbinger Publications
Trying Again: Guide to Pregnancy After Miscarriage, Stillbirth and Infant Loss, Ann Douglas and John R. Sussman, M.D., Taylor Trade Publishing
Empty Arms: Coping with miscarriage, stillbirth and infant death, Sherokee Ilse, Wintergreen Press

Other Organizations

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Stillbirth and Newborn Death

The birth of a child is one of life’s greatest celebrations. Especially during a multiple pregnancy, parents fantasize about their babies, about walking them, showing them off to friends and family, trying out names and how they sound. When the outlook is positive, those close to the couple share in the journey as excitement and anticipation mount.

Yet when one, more or all of the babies dies by miscarriage or stillbirth, parents at times are encouraged to consider a miscarriage or stillbirth as something less than a “real” death. People around you often want to help, but find it difficult to understand the special circumstances of your loss. Information from Multiple Births Canada and other resources mentioned in this article can assist them say and do things that are helpful and avoid those that are hurtful.

If you do lose one, more or all of your babies, you may wish the birth and/or death certificates to reflect the fact that your baby(ies) was part of an appropriate multiple birth set, i.e. loss of one triplet does not make it a “twin birth”, loss of two quadruplets does not make it a “twin birth” and so on. You may need to be vocal about your wishes as some hospitals may record only the surviving baby(ies) and not your accurate multiple birth.

Stillbirth and Newborn Death

For women carrying multiples, prematurity remains the leading cause of death. Approximately 10% of all perinatal deaths are multiple birth children (Multiple Births Canada’s Fact Sheet, Multiple Birth Facts & Figures, 1998).

In spite of our best precautions, premature birth can still occur. There are no guarantees against the early delivery of your babies. Even in spite of appropriate and timely intervention by hospital staff, a loss of one, more or all of the babies may still occur. If such is the case, you will no doubt be:

  • grieving for your baby(ies);
  • grieving the loss of a unique type of parenthood;
  • feeling shocked, empty and alone with disappointment, anger, sadness and grief;
  • wondering how this could happen and fear that you might not have other children.

The loss of one baby from the multiple birth set, can present complicated emotions to deal with:

  • why this baby and not the other?
  • Did I resent or fear the thought of looking after two, three or four babies and thereby cause this to happen?
  • Did I “wish” one or more babies “away” and cause this to happen?
  • Did my preference for one sex cause this baby to die?
  • How will I tell the survivor(s) about her sister and when?

While these thoughts are normal, they also increase the burden of guilt and grief. Don’t leave these feelings bottled up inside of you. Talk to a grief counsellor, good friend, hospital staff, your partner or religious support person, in order to assist you in putting your feelings into perspective.

Losing one, more or all of your babies leaves the parents and those who care about them to deal with complicated issues. Some of these issues are:

  1. Not only have you lost a baby(ies), but you have also lost a unique parenting experience. Seeing other people with their multiples is a painful reminder of your loss, and may trigger feelings of envy, anger, failure or sorrow. In addition, when there is (are) a surviving child(ren), it can be difficult to resolve the conflict between the two extreme emotions that you are feeling – that is, the joy of the birth of a baby(ies) and the sorrow of the death of a baby(ies).
  2. Your feelings may include rage, shock, numbness, guilt, panic, being out of control, powerlessness, confusion, and/or denial. You are adapting to a new reality and it takes time to adjust. In fact, we are never the same after the death of a child(ren). We adapt and go on, but we are not the same. Grief is a journey, not a destination. Expect powerful feelings to resurface at different times as you walk the rocky road. It is healthiest to allow yourself the neeed time to experience them as they arise, rather than suppressing them.
  3. You may not wish to be touched or held for a period of time after your loss because of a fear of losing control of your emotions. At work or in social situations, you may not wish to discuss your children or your loss, afraid that you will break down in tears and be unable to stop the flood. It helps to tell family, friends and co-workers what you do and don’t want to talk about. Every parent is different. While some want and need to talk about their distress with anyone who will listen, others wish to keep their personal pain separate from their social responsibilities. It helps to tell family, friends and co-workers what you do and don’t want to talk about.
  4. You may find that people pay more attention to the live baby rather than the fact that one (or more) died. They may feel that dwelling on the dead baby may make things more uncomfortable for you. Feel free to speak up if you wish to speak of your dead child(ren). Others will be more open about their thoughts if they know you are happy to hear your dead baby’s name and consider him or her to be a special part of your family.
  5. On the other hand, you may wish, yourself, to push all thoughts of the dead baby(ies) out of your mind and concentrate on your surviving baby(ies). You might wish others would stop reminding you of the baby(ies) you have lost. You need not feel guilty about this normal reaction. Parents can only cope with so much at once. With newborns, especially when they are premature or ill, it is common for parents to devote their energy to their living children and delay grief until a later time. In due course, you will find the right way to acknowledge the child who died.
  6. Parents often hear inappropriate comments that are meant to comfort them but in fact, do exactly the opposite. To hear “It’s not the same as losing a baby, this one never drew breath.” or “You are young, you can have other children” is devastating, even if the comment is well intentioned.”At least one survived.” [I am truly grateful, but one crib is still empty.]
    “It’s God’s will. They’ve gone to a better place.” [There is no better place for babies to be than with their parents! ]
    “It’s for the best, she/he would have been disabled. [Death of a child is not “good” and not necessarily easier to handle than disabilities.]
    “You have a healthy baby, just forget the other and get on with your life.” [You have 2 legs. If one was amputated, how would you feel if I said “you have one healthy leg, forget the one you lost and move on?”]
    “You could never have handled quadruplets.” [Death of a child is not easier to handle than mounds of diapers or huge grocery bills!]
  7. Communication is important, and a counselor may help bereaved parents avert losing relationships with family or friends. People often call two surviving triplets or quadruplets “twins”. They need to know what you want to call them. Likewise, one mother reported one of her twin daughters was born very ill and died in the hospital after a short life of two months. Her mother-in-law focused on the surviving, healthy baby, sending the parents a card congratulating them on the “birth of their daughter”. The dead sister was never mentioned, even though she lived for two months, was named and given a funeral. A rift developed between the mother and mother-in-law, with hurt, anger and hostility at the lack of acknowledgement of one grandchild’s birth and death.
  8. Recognize that you will have limits. Your pain may be so intense that you will have nothing to give to the rest of the family or spouse. Be honest and let them know when you need some space for the time being.

Memories

It can be very helpful for parents to see, hold and touch their dead baby or babies. I feel very strongly that we cannot say “Good-bye” until we have said “Hello.” No parents have ever expressed to me their regret at having seen and held their babies, but several have expressed regret that they did not. Sensitive and caring hospital staff can encourage parents to hold their baby(ies), and bathe them if they wish. You can take photos of the deceased babies separately and together, with any surviving babies from the multiple birth, and with other siblings if you desire this. Hospital staff are often exemplary in supporting families at this difficult time, making it as easy as possible for you, although they cannot change the tragic reality of death. Parents are often given specially designed Memory Boxes, one per baby, which may include: the blanket the baby was wrapped in, a lock of hair when possible, plaster hand and foot prints, an outfit the baby wore, hospital bracelets and several photos of each baby. Such special items are cherished as tangible evidence of the reality and value of a baby who did indeed live, even if only in dreams.

There are companies and artists who can create drawings of your babies, or unite separate photos of babies with computer imaging to create a group picture. These tasteful and precious photographs or sketches can provide parents with much comfort. As one Dad put it “.it [the photograph] proved to the world that our son was real.”

This article was written with grateful input and assistance from:
Dr. Elizabeth Pector, Illinois, U.S.A.

Reading Resources

Twins, Triplets and More, Elizabeth M. Bryan, M.D., St. Martin’s Press
Guidelines for Professionals: Bereavement, Bryan, EM; Hallett F, Multiple Births Foundation, London England http://www.multiplebirths.org.uk
Living Without Your Twin, Betty Jean Case, Tibbutt Publishing
Bereavement in Multiple Birth, Part 1: General Considerations, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, November, 2001
Bereavement in Multiple Birth, Part 2: Dual Dilemmas, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, May, 2002
The Worst Loss: How Families Heal from the Death of a Child, by Barbara D. Rosof, Henry Holt
Empty Cradle, Broken Heart: Surviving the Death of Your Baby, Deborah L. Davis, Fulcrum Publishing
Men & Grief, Carol Staudacher, New Harbinger Publications
Trying Again: Guide to Pregnancy After Miscarriage, Stillbirth and Infant Loss, Ann Douglas and John R. Sussman, M.D., Taylor Trade Publishing
Empty Arms: Coping with miscarriage, stillbirth and infant death, Sherokee Ilse, Wintergreen Press

Other Organizations

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One is Alive, One is Not

Please note that the information contained herein is general in nature and does not cover every possible situation.  If you have concerns about any aspect of your pregnancy, please consult your doctor.

For many months, you have delighted in carrying your precious babies beneath your heart.  They are very active and your belly grows almost daily.  Beating hearts have been visible on the ultrasound screen as perhaps have legs, arms or spines, depending upon which way they are lying.  One of the babies though is smaller (usually referred to as small for gestational age) and a little weaker than his co-multiple(s).

Then the unthinkable happens: the smaller one has passed away.  It is still early enough  in the pregnancy that it needs to continue for several more days, or even weeks, to give the survivor(s) the best chance at survival outside the womb.

This unbelievable and devastating situation is almost too much to absorb, let alone comprehend.  Shock as well as many questions leap into the parents’ minds in an attempt to understand what has occurred and why.  Following are some frequently asked questions:

Q: What is going to happen to my surviving baby(ies)?

The death of a multiple before 16 weeks of pregnancy generally creates no increased risk for the remaining baby or babies.  An after 16-weeks death of a multiple with a separate placenta from the other(s) is also not too likely to cause any problems.  When a deceased fetus’s placenta is shared with a co-twin (monochorionic), there is some risk of problems for the survivor, but not always.  With the death of a fetus when there is a survivor(s), the mother can expect to be closely monitored until birth. Your doctor can discuss your particular situation and explain a management plan for your pregnancy until birth.  While the mental strain can be very taxing, many women continue their pregnancy and have a healthy survivor(s).

Q: Will my dead baby hurt my living baby(ies)?

If the surviving multiple(s) is healthy itself, there will be no affect on the living baby(ies).

A deceased baby’s body begins to be broken down in utero and is reabsorbed by the mother’s body and/or the survivor’s placenta.  Depending upon how long after death it is delivered, depends upon what its appearance will be like when it is delivered.   Delivery can be expected to be earlier than previously planned if the babies share placentas and/or sacs.  Mom is carefully monitored until birth, so that the doctors can make timely decisions if needed.

Q: Did my baby ‘kill’ his sibling?

No, one baby didn’t ‘kill’ the other.  The deceased fetus usually has substantial health problems through no one’s fault (e.g. anomaly within a larger organ such as the heart). Through ultrasounds, it is sometimes possible to diagnose that one baby is weaker and has a compromising health problem(s).  In twin-to-twin transfusion syndrome (with monozygotics), for example, the mother is closely monitored to try and prolong the pregnancy as long as possible in order to give both (or all) babies the best chance.  With some medical issues within the womb, however,  it isn’t always possible to successfully intervene and one baby dies.   Sometimes the death cannot be explained until the baby and the placenta can be examined after birth and even then, the reason for the death may not be identified.   Depending on when a fetus passed away and how many days or weeks later the mother gives birth, it is not always possible to identify the cause of death due to deterioration of the fetus and/or placenta.

Q: How is this going to affect my own health and emotions?

Physical complications for the mother after one multiple dies in the womb are uncommon. Careful monitoring of both mother and surviving baby(ies) during the rest of pregnancy can detect any signs of concern.   Delivery may occur earlier than previously planned because of this changed situation.

Emotionally the situation can be quite different.  Some women report feeling fear, isolation, confusion, devastation or horror.  Some report feeling particularly close to their dead multiple because they know this is the only time they will have him/her. They report a great sadness through the rest of pregnancy, unable to find any joy in the approaching birth because they will need to give up that baby. Others push grief aside, fearing it will harm the remaining child(ren) or cause preterm labor. They dedicate their energy to hopeful thoughts about the survivor(s).  Some hang on to a belief that there has been an error and at delivery, there will be two (or more) healthy and alive babies.  All of this is normal.

Q: What will the delivery be like?  What will happen?

Your doctor, hospital staff and grief counselors can help you plan a birth experience that honors your deceased child while meeting the medical needs of your living baby.   Depending upon at which stage the baby died, you may need a death plan as well as a birth plan.  Communication with your doctor about the delivery will help clarify what will happen and how things will proceed.  Don’t be afraid to discuss with your doctor your needs and fears.

Q: What will our dead baby look like at delivery?

Your baby’s body will be small (as compared to its co-multiple[s]) but recognizable as a baby if death occurred after the 14th week of pregnancy. There will likely be some distortion of features and discoloration (bruising).  Discussion with your healthcare provider or a grief counselor can sensitively prepare you for your baby’s appearance, and help you choose whether to view him/her after birth or not.   Some families choose to view their baby regardless, some don’t want to view the baby.  Don’t be pressured into doing anything that you don’t feel comfortable doing.  Whatever you decide to do is what is right for you.  You may wish photos to be taken either by yourselves or ask the staff to take them for you, should that be easier.  Photos can be an important consideration as this is the only time both (all) multiples will be together, should you wish to do so.   The baby can be wrapped in such a way as only a foot or feet, hands or face is visible for the photos.  The hospital staff will be able to guide you.  You may chose to have the photos taken, but put them away and not look at them until a later date when you feel more comfortable viewing them.  Sometimes one parent will wish to see the baby and/or photos and one will not.  People do not all grieve in the same way so understand that your partner may make a different choice from yours.  There is no right or wrong way to proceed, only the way that works for you.

Q: Can we spend some time with our baby?

Yes, you can spend time with your deceased baby, if you want to.  Be sure and let the staff know ahead of time if this is what you want to do.  Have a note written in your file indicating that this is what you wish to have happen.   You can take as long you want or need to take with your baby.  In addition, some parents have hand and foot prints taken as a keepsake if it is possible.

Some options to consider for the remainder of your pregnancy: 

  • If you do not wish to view the deceased fetus(es) during ultrasounds inform the technician.   The monitor can be turned to another direction.
  • Doctor’s appointments may be booked when no other parents of multiples will also be present.  If this is better for you, then you can request it.
  • More frequent doctor visits and/or testing will occur in view of your situation. This may be reassuring to you.
  • Talk with your doctor if you have any fears about the surviving baby’s health.
  • You can see your baby(ies) at delivery should you wish to do so.  If you do not wish to do so, that is OK too.  The hospital staff, at delivery, can help you with the decision, if that works for you.
  • If you do not wish to view your deceased baby, you still can hold him/her, usually wrapped in a blanket. This relieves the aching arms felt by some grieving parents.
  • If you wish an autopsy to be performed discuss it with your doctor.
  • You may need or wish to make plans for burial, cremation or hospital disposition of your baby’s body.
  • Consider if you have photos taken, they may also be important for your surviving multiple(s) to view and to help you begin the discussion of how he/she began life.
  • In any photos you may wish to include yourselves and any older siblings so you have a record of the whole family together.  For some families photos confirm that they truly gave birth to multiples and reduce later feelings of confusion.
  • Computer programs can create a combined photo from two or more separate images.  Some parents who did not take photos of the babies together, can thus create a combined photo.
  • Ask for the survivor’s birth certificate to clearly state that the child was one of the original number of babies conceived. The death of a triplet does not create twins.
  • Some hospitals offer an honorary birth certificate for the child who died.  Ask for one if you would like one.
  • Children are not interchangeable and you do not have to listen to such comments as “As least you still have one” or “You couldn’t have handled three.”   Feel free to inform the speaker that such comments are painful and only add to your grief.
  • Contact Multiple Births Canada’s Loss Support Network which offers a monthly e-newsletter, Forever Angels.  You are not alone.  Other families have gone through the same thing and it can be very helpful to connect with them.

Sources

Bereavement in Multiple Birth, Part 2: Dual Dilemmas, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, May, 2002

Reading Resources

  • Twins, Triplets and More, Elizabeth M. Bryan, M.D., St. Martin’s Press
  • Guidelines for Professionals: Bereavement, Bryan, EM; Hallett F, Multiple Births Foundation, London England  http://www.multiplebirths.org.uk
  • Living Without Your Twin, Betty Jean Case, Tibbutt Publishing
  • Bereavement in Multiple Birth, Part 1: General Considerations, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, November, 2001
  • The Worst Loss:  How Families Heal from the Death of a Child, by Barbara D. Rosof, Henry Holt
  • Empty Cradle, Broken Heart: Surviving the Death of Your Baby, Deborah L. Davis, Fulcrum Publishing
  • Men & Grief, Carol Staudacher, New Harbinger Publications
  • Trying Again: Guide to Pregnancy After Miscarriage, Stillbirth and Infant Loss, Ann Douglas and John R. Sussman, M.D., Taylor Trade Publishing
  • Empty Arms: Coping with miscarriage, stillbirth and infant death, Sherokee Ilse, Wintergreen Press

Support Organizations and Web Sites

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Grief and Its Impact on a Marriage

The loss of a baby or babies can and does have an impact on a marriage as each parent attempts to regain their equilibrium and balance after such a devastating loss. The loss of our child(ren) changes us forever. We lose our innocence and the future is forever changed. Add to this the fact that men and women grieve differently, and the impact on a couple’s relationship is not always a positive one.

Generally speaking, women tend to be more open about what they are feeling than men. Women may have one or two girlfriends, a sister or mother with whom they “open up,” express what is on their minds and how they are feeling. Men, on the other hand, don’t usually have close relationships with other men which would include speaking about their emotions or the sharing of feelings and thoughts. Traditionally men have been inundated with messages such as “suck it up”, “crying is for wimps” and “act like a man”. In such an atmosphere, with no safe place to express their emotions, men have not been dealt a fair blow when it comes to expressing those inner emotions.

It is important to note, however, that things are changing. Thankfully there is more dialogue regarding men’s feelings, not only by the men themselves but also by society as a whole. Parenting magazines are offering support articles for men on how to help a partner with breastfeeding, through the pregnancy, dealing with loss of a baby or babies and more. Internet Sites have sprung up providing ample opportunity for men to write about their feelings, express their pain, joy, feelings of insecurity and fears about parenting. Support groups for men and dads are more readily available in many communities. Book stores now carry books for fathers regarding parenting, relationships and grief. Oprah Winfrey has done a couple of shows regarding men and their inner feelings and fears. All of this is important and hopefully, over time, will help bridge the gap between men and women!

It is acknowledged that not all mothers and fathers experience difficulties in connecting while grieving. Some couples are brought closer together, communicate regularly and feel much closer in their time of greatest need. What I would like to explore in this article, however, is the possible negative impact of the loss of one or more of babies on a couple’s marriage. Further, understanding that men and women grieve differently and what some of those differences can be is helpful. We also need to understand a little bit about Grief itself:

  • Grief is a journey, not a destination;
  • Grief has no timeline;
  • Grief is personal. There is no right or wrong way to grieve;
  • Just when you think that you are feeling OK and doing well, Grief will “rear its head” and you may feel overwhelmed all over again. This is normal;
  • Some of the triggers for Grief could be a sentimental song, a beautiful sunset, a singing bird, a garden of flowers blowing in the wind, watching another child play and laugh, or for no apparent reason at all;
  • Grief can leave individuals with a sense of isolation, loneliness, anger, powerlessness, guilt and/or fear. All of these emotions are normal;
  • Grief has been described as an “open wound” which heals over time, but which also leaves a scar.

When we look at Grief from some of these perspectives, it stands to reason that mother and father will not always be on the same time line as each other and or be grieving in the same manner. Initially a couple may cling together and share their pain with tears, embraces and conversation. It isn’t unusual for the father to be the one in charge of making funeral arrangements, talking to the undertaker, hospital staff, choosing a casket, working through the finances and paperwork. He may also have to deal with other children at home, handle his job and the ramifications of his absence, worry about his wife and answer questions from family and friends. One father indicated after the loss of one of their babies, that he was sick and tired of friends calling and asking him how his wife was doing! “What about me? I lost a baby too!” They had skipped right over him and minimized his pain and grief. Juggling all of this and trying to find time to grieve the loss of his baby or babies is a monumental task for a Dad to face.

Mother probably has family and friends whom she can talk to about her baby or babies. She may need to focus on physically getting better in the case of having had a c-section, and may also need to take care of a surviving co-multiple(s).

After the funeral, it may be harder and harder for Mother and Father to “get together” on an emotional level, to speak about what they are feeling: of their fears for the future or the fears each has for the survivors of their multiple birth – “If I get attached to this baby, will she die too?”. One may “blame” the other for the loss, even inadvertently. It may become necessary to seek some bereavement counseling from: a cleric, grief counselor, social worker or psychologist who specializes in grief issues. Your family doctor can assist you in this regard or refer you to an appropriate support individual.

If, as a couple, you already have a child or children, this may add another difficult component to your grieving journey, or not, as each individual family will decide. Sometimes the need to continue to be available for your other children can be a boon. Having to remain mobile, available and responsive, for one or both parents, can sometimes be helpful in spite of mourning for a lost child or children.

Sometimes one or both parents may find the opposite and find it difficult to continue to be an attentive and available parent. One or both may experience feelings of being overwhelmed, pressured, resentful or of wishing to simply withdraw. All of this is normal and doesn’t mean you are a bad parent. Try your best to keep the lines of communication open with your children. Let them know you are feeling very sad at the moment, need some quiet time, or are thinking of their dead brother or sister. Let the child know that they didn’t cause your sadness but you are sad, nevertheless. It will be helpful for him (or them) to know that feeling sad is a part of grieving and your reactions and feelings were not caused by them. By being honest with your child or children about what you are feeling, you will be helping them and yourself, even if it doesn’t feel like it at the time.

It may be helpful to try to keep in tune with whatever your partner may be feeling and to try and distract your other child or children for a time, in order to give your partner some space to him/herself. A role reversal may occur at another time for the other spouse.

Here are some suggestions to aid a marriage in time of grief. You and your spouse may add some others that will work for you.

  1. Don’t expect your spouse to be a tower of strength when he or she is also experiencing grief.
  2. It is very important to keep the lines of communication open.
  3. Be sensitive to your spouse’s personality style. In general, he or she will approach grief with the same personality habits as they approach life. This may be in a private manner or open and sharing, or some place in between.
  4. Talk about your loved one(s) with your spouse. If necessary, set up a daily time period when you both know that it is time to talk about your loved one(s).
  5. Seek professional help of a counselor if depression, grief or problems in your marriage are getting out of hand.
  6. Deal with things as they occur. Do not overlook or ignore anger-causing situation. It is like adding fuel to a fire. Eventually there will be an explosion.
  7. Remember that you loved each other enough to marry. Try to keep your marriage alive: go out for dinner or an ice cream cone; take a walk; go on a vacation.
  8. Be gentle with yourself and with your mate too.
  9. Join a support group for bereaved persons. Attend as a couple, come by yourself or with a friend. Do not pressure your spouse to attend with you if it is not his or her preference.
  10. Join a mutually agreeable community betterment project.
  11. Do not blame yourself or your mate for what you were powerless to prevent. If you feel personally responsible or blame your spouse for your loss, seek immediate counseling for yourself and your marriage.
  12. Remember that there can be a loss of sexual desire or hypersexuality during the grieving process. You can discuss this with your mate.
  13. Be aware of unrealistic expectations for yourself or your mate. Try to remember that your spouse is doing the best that he/she can.
  14. Marital friction is a normal part of any marriage. Don’t blow it out of proportion at this painful time.
  15. Try not to let everyday irritants become major issues. Talk about them and try to be patient.
  16. Be sensitive to the needs and wishes of your spouse as well as yourself. Sometimes it is important to compromise.
  17. Work on your own grief instead of wishing that your spouse would handle his/her grief differently. You will find that you have enough just handling your own grief. Remember, when you help yourself cope with grief, it indirectly helps your spouse.
  18. As one grieving mother stated: “Value your marriage. You have lost enough!”
  19. Hold on to Hope. With time, work and support you will survive. Life will never be the same, but you can learn again to appreciate it and the people in your life.
  20. Allow yourself and your partner to feel whatever it is you are feeling without judging yourself or each other.

Bibliography

Grief and its Impact on a Marriage, Fact Sheet by Bereaved Families of Ontario – Ottawa.
Men & Grief, by Carol Staudacher, 1991, New Harbinger Publications, Inc.
Healing Your Grieving Heart: 100 Practical Ideas, by Alan D. Wolfelt, Ph.D., 2001, Companion Press

Other reading resources:

When a Baby Dies: A Handbook for Healing and Helping, by Rana K. Limbo and Sara Rich Wheeler, 1993, RTS Bereavement Services
The Worst Loss: How Families Heal from the Death of a Child, by Barbara D. Rosof, 1995, Henry Holt and Co.
Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth and Infant Loss, by Ann Douglas and John R. Sussman, M.D., 2000, Taylor Publishing Co.
Trying Again After Loss, by Ann Douglas and Lynda P. Haddon

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Grieving Grandparents

One of the most overlooked areas of grief is the grief experienced by grandparents. Your child has just suffered the death of their child or children and you could not protect nor shield him/her from this devastating loss. Further, you have lost your grandchild(ren). Your own hopes and dreams for the future are shattered. To further complicate matters, the grief process is a long, often painful journey which has no timeframe and which is very personal. There is no right or wrong way to grieve, only your way. With the loss of a baby(ies), we are changed forever. Hopefully the following will assist you, as the Grandparents, in coming to terms with and handling not only your own grief journey but also that of your child.

It is natural to want to protect one’s child from pain but that is not always possible. As you watch your child suffer and the dreams for the future are shattered with the death of your grandchild(ren), you can only stand by and watch. You feel powerless. It is difficult to offer comfort when you are also grieving yourself. You must try to offer comfort at the same time as you grieve.

  1. Take your child in your arms. Hold them, cry with them. Let them tell you how they feel. Listen with your heart, soul and with love. Words aren’t particularly necessary as you hold, support and love each other.
  2. If you are able to share some of your own feelings of sadness, do so. When we share difficult moments together, it makes the burden a little lighter. Concealing your own pain or feelings may only make them feel that you don’t care.
  3. Try to avoid telling your child how they should act. “You can have another baby.” “Try to pick up the pieces and get on with your lives, you are young.”
  4. If at all possible, try to see the baby(ies), to hold him/her, take photos with everyone, name the baby(ies). Encourage your child to do the same. Do not be afraid to use the baby’s name. After all he/she existed and was a real part of your family’s fantasy and future. To ignore the pregnancy or the loss will only make the mountains higher.
  5. Remember that the loss of this baby(ies) is not your fault. You did not cause the baby(ies) to die, but you can be supportive and available when possible to do so.
  6. Do not feel badly if your grief is initially ignored. As the parents try to come to terms with a new reality, they may inadvertently exclude you and not recognize the depth of your grief.
  7. Avoid blaming: “Do you think you exercised too much? Or drank too much coffee?” You might ask, “I know I wonder if I could have done anything differently, do you have similar feelings that are bothering you?” Try not to judge nor interpret any responses.
  8. Take care of yourself. Make sure you eat nutritiously and that your child and their partner does too. One of the first things that falls to the side after a death is appetite. A snack of cheese, fruit or vegetables ensures that health and strength are kept up. Try also to get adequate sleep and exercise during this painful period.
  9. Try to keep the lines of communication open between family members. Offer to assist with meals, childcare if there are other children, share resources and books.
  10. There are things that you can do to celebrate the memory of your grandchild(ren):-
    • plant a garden or a tree in a local park;
    • do some volunteer work;
    • make a donation to a favorite charity;
    • write about your feelings and perhaps give the journal to your child at a later date;
    • do something special on anniversaries or birth/death days.
  11. Grief is a very powerful emotion. Remember your other grandchildren if you have them. Don’t let your grief overshadow your ability to interact with them or others.
  12. If your child and spouse feels comfortable with it, you may wish to include the child(ren) who died whenever speaking about your grandchildren, especially when mentioning how many you have.

One bereaved grandmother advised that she was told by her son and his wife (both doctors) that she must never refer to the babies again (they died at 5-1/2 months gestation). This grandmother felt blocked and ignored regarding her own feelings. She felt that being doctors, they should be in a better position to understand grief, loss and how to deal with them. This is not always the case and while no doubt being able to dispense wise advice to their patients, were not able to acknowledge their own pain and loss. Denial regarding their loss was also inflicted on the grandparents. If such is the case for you, join a bereavement support group, try some grief counseling or speak to a good friend, doctor or religious support person. You don’t have to go through this alone. Your feelings are real and painful. You, too, have suffered a loss but you may need to explore some avenues on your own in order to obtain appropriate support.

Other Resources

Grieving Grandparents, by Sherokee Ilse and Lori Leininger, Wintergreen Press Inc.

Loss Organizations

Loss Support Network, Multiple Births Canada, www.multiplebirthscanada.org

Centre for Loss in Multiple Births (CLIMB), Alaska
E-mail: climb@pobox.alaska.net

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Trying Again After Loss

By Ann Douglas and Lynda P. Haddon

It takes courage to try again when your previous pregnancy has ended in miscarriage, stillbirth, or the death of an infant(s). You know that there’s a chance that you may experience another loss, but you’re willing to risk it all for a shot at the ultimate prize: a healthy baby(ies) that you can call your own.

As committed as you may be to having another baby, it’s perfectly normal to feel a bit nervous about planning another pregnancy. After all, you already know that not all pregnancies result in picture-perfect happy endings. Like it or not, the innocence that you enjoyed when you found yourself pregnant for the very first time is gone forever. You can’t get it back.

Don’t be surprised if you find yourself experiencing a smorgasbord of different emotions when you first make the decision to start trying to conceive – everything from joy to worry to outright panic. Some days, you may feel convinced that becoming pregnant again is the only thing that will bring joy back into your life. At other times, you may wonder if you’re crazy to even think about exposing yourself to the possibility of heartbreak again.

You may also find that your partner has mixed feelings about trying again, whether or not he’s actually willing to express these emotions to you. After all, he’s not just worried about the well-being of any future babies you may conceive: he’s also worried about the impact of any subsequent losses on you as well as dealing with his own feelings of loss, helplessness and grief.

If you’re having difficulty deciding whether or not the two of you are actually ready to embark on another pregnancy, you might find it helpful to consider the following questions:

  • Have you both had a chance to work through some of your grief for the baby or babies who died? Grief can be an exhausting emotion – one that demands far more of your time and attention that you want to give it. Grief is unpredictable and can come to the fore with previously unknown and unplanned stimulants. If your baby(ies) died recently, you may still be going through a very rough time emotionally and you may not be able to embark on another pregnancy just yet.
  • How would you cope if you were to experience fertility problems? If you don’t think you’d be able to weather the emotional highs and lows that couples typically experience when they are having trouble conceiving, you might want to postpone your baby making plans a little while longer. While the fact that you managed to conceive in the past means that you have an excellent chance of conceiving again this time around, you have, at best, a 20% chance of conceiving in any given menstrual cycle. That means the odds of being disappointed during the first month or two of trying are extremely high. Are you emotionally strong enough to cope with that disappointment?
  • How would you cope if you were to experience the death of another baby(ies)? While you may not want to even consider this possibility, it’s important to go into your subsequent pregnancy with your eyes wide open. If you’re still feeling emotionally fragile, it may be too soon to jump back into the fire again.
  • How would you cope with the stress of a subsequent pregnancy? The worry doesn’t end when you manage to conceive. If anything, it’s just beginning. That’s why it’s important to be sure that you’re up to coping with the stress of what could very well be the most nerve-wracking 40 weeks of your life.
  • Are you expecting too much of your subsequent pregnancy? If you expect a new pregnancy to wipe away the grief you are feeling for the baby or babies you lost, you are setting your expectations too high. No other baby can possibly take the place of that other baby in your heart. We are different people than we were before our loss. We can learn, however, to place our grief in a place that permits us to move forward with our lives, albeit forever changed.
  • While losing one more or all of multiple birth babies carries its’ own unique issues, it is important to have tried to come to terms as best as possible with these issues while considering another pregnancy. There is the loss of a unique parenting style. Parenting a singleton child is very different from parenting twins, triplets, quadruplets or more. While pregnant with these multiple babies, fantasies run high as we proudly show them off to friends and families, walk and bathe them in our minds before birth. In our mind, we may even have struggled with how to get the triplet stroller into the car. This unique parenting style is lost when the multiple birth pregnancy changes.
  • Have you considered the possibility of another multiple birth? When multiple birth babies are conceived “spontaneously” or without fertility assistance, there is a marked increase in your chances of conceiving multiples again in subsequent pregnancies. Your age is a facilitating factor as is if you have already had several children. It isn’t unheard of to have multiples again after loss. And, of course, those using fertility assistance will also increase their chances of a repeat multiple birth. Consider the family who lost triplets at 22 weeks and then became pregnant with triplets again and carried successfully. Or the family who lost a twin then successfully delivered twins again 18 months later.

One mother who lost twins and found herself pregnant again six months after their loss had some important feedback for others. She noted that she and her husband had difficulties marking the first year anniversaries that arise after a loss: Father’s Day, Mother’s Day, Birth/Death Day, Christmas, etc. while being pregnant with a new baby. While their new baby is a much wanted Treasure, she advises that parents need to be aware of possible conflicting feelings about being pregnant at the same time as dealing with loss emotions around the anniversaries of losses. These unexpected emotions took them completely by surprise.

In addition, Mom noted that as her subsequent pregnancy inadvertently followed one year later the time line of their lost pregnancy, they became aware that they could have been preparing for a birthday party for two two-year olds rather than celebrating an upcoming first birthday for a singleton. The family was aware that but for their loss, their lives would have been totally different and they needed to work through their feelings in this regard.

While there are a lot of factors to weigh in deciding whether or not you’re ready to start trying to conceive again, your best bet is to listen to your heart. Most couples instinctively know whether they’re ready again or not. Consider these words of wisdom from Cynthia, 35, who experienced a series of miscarriages before giving birth to her second living child last year: “If you have to consciously decide, then it’s probably the wrong time. It’s kind of like being in love. You always wondered how you would know when you were, but when you were, you just knew it. I think it’s the same. When you’re ready to try, you’ll want to try. It’s really that simple.”

Ann Douglas is the co-author of Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss (Taylor Publishing, October 2000) and The Unofficial Guide to Having A Baby (IDG Books, 1999). Ann has written over 30 books, many addressing a wide variety of parenting issues. She is the mother of four living children as well as Laura, who was stillborn in October of 1996 as the result of an umbilical cord knot. She can be contacted via her web site atwww.having-a-baby.com

Lynda P. Haddon has been working extensively with multiples and their families for over two decades. She has three grown daughters, including dizygotic twins. Her first pregnancy ended in miscarriage. Lynda has spoken on several occasions to healthcare professionals regarding the unique issues of loss in multiple birth. Lynda has been Chair of the Loss of Multiples Support Network for Multiple Births Canada for 15+ years and has been providing support and assistance to bereaved multiple birth families for over 20 years. She has also revised and revamped Multiple Births Canada’s three Loss booklets and written many articles on various aspects of loss in multiple birth.